The overall goal is to indentify best practices for improving health outcomes for patients with asthma using comparative effectiveness research within an AHRQ PBRN. This goal will be achieved by completing the following aims: (1) Create a centralized database for comparative effectiveness research on asthma by combining clinical and billing data from one of the largest healthcare systems in the country (Carolinas Healthcare System) with data from the school system, Medicaid, and patient and community-level datasets;(2) Deploy a fully developed integrated approach to asthma management based on the Chronic Care Model;(3) Develop and implement a "shared decision making" approach for asthmatic patients from disadvantaged backgrounds;(4) Implement an electronic data collection system for an existing CDC funded school-based asthma intervention that will allow program evaluation and link school nurses with providers;(5) Evaluate and compare the effectiveness of these three asthma management strategies on: overall healthcare consumption and medical costs;quality of life, school absenteeism and performance;asthma clinical measures;and medication utilization;and (6) Disseminate findings across the state via the statewide PBRN and other network partners. This project has the potential to impact over 30,000 asthma patients across the Carolinas including many patients from disadvantaged backgrounds. PUBLIC HEALTH RELEVANCE: This project will develop a centralized database for comparative effectiveness research using hospital as well as community data in order to evaluate three interventions implemented with the goal of improving asthma outcomes within 75 practices and 171 schools in North and South Carolina. The interventions will include: (1) an integrated care model with an electronic medical record decision support system, an electronic asthma action plan, links to community resources, and training in practice redesign and rapid cycle process improvement;(2) a shared decision making intervention for underserved community members designed to enhance patient input in the development of the treatment plan and improve self-management;and (3) a school-based intervention lead by school nurses with links to primary care providers. Results from this study and the means to implement the interventions in everyday clinical settings will be disseminated across the state via the statewide AHRQ practice-based research networks and area health education centers.